scholarly journals An Investigation of a Novel Dural Repair Device for Intraoperative Incidental Durotomy Repair

2021 ◽  
Vol 8 ◽  
Author(s):  
Kartik Shenoy ◽  
Chester J. Donnally ◽  
Evan D. Sheha ◽  
Krishn Khanna ◽  
Srinivas K. Prasad
Keyword(s):  
Simulation Model ◽  
Csf Leak ◽  
The Novel ◽  
Clinical Experiences ◽  
Dural Repair ◽  
Novel Device ◽  
Clinical Scenarios ◽  
Dural Tears ◽  
Incidental Durotomy ◽  
Tools And Techniques

Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair time, CSF leak pressure and nerve root avoidance in the simulation. The results were generally replicable clinically, however, numerous additional clinical scenarios were also encountered that the simulation model was unable to capture due to various inherent limitations. The simulation model design, potential contributors to watertightness, clinical experiences, and limitation are discussed.

scholarly journals Use of Tissue Glues in Endoscopic Pituitary Surgery: A Cost Comparison

2010 ◽  
Vol 37 (5) ◽  
pp. 650-655 ◽  
Author(s):  
Lukas H. Kus ◽  
Brian W. Rotenberg ◽  
Neil Duggal
Keyword(s):  
Cost Analysis ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Significant Proportion ◽  
Pituitary Surgery ◽  
Csf Leak ◽  
Dural Repair ◽  
Surgical Sealant ◽  
Clinical Scenarios ◽  
Consensus Values

Background:Post-operative cerebrospinal fluid (CSF) leaks are a common complication of endoscopic pituitary surgery and account for a significant proportion of hospital costs associated with this procedure. Tisseel® is a tissue glue commonly used as an adjunct in dural repair but is not optimal for this purpose. DuraSeal® has several properties advantageous for dural repair but is not widely accepted in Canada partly due to its increased cost.Objective:A cost analysis of DuraSeal® versus Tisseel® in endoscopic pituitary surgery.Methods:A cost analysis was performed based on typical endoscopic pituitary surgery cases performed at our tertiary care institution. Operating room, hospital admission, and surgical sealant costs were obtained directly while estimates of patient recovery time and post-operative CSF leak rates were based on consensus values reported in the literature. Outcomes were reported for various possible clinical scenarios of sealant use.Results:In a model where surgical sealant is employed only in high-risk cases, use of DuraSeal® allows for a yearly cost savings of at least $4486.72. If surgical sealant is used in all cases, regular use of DuraSeal® versus Tisseel® either marginally reduces yearly costs or increases them by a maximum of $7619.25, depending on the case volume and estimated post-operative CSF leak rate.Conclusion:In most clinical scenarios, use of DuraSeal® in endoscopic pituitary surgery may reduce overall yearly hospital costs compared to Tisseel®.

EFFICACY OF A NOVEL DEVICE TO DETECT, ALERT AND RESOLVE NEONATAL APNEA - PILOT STUDY

2019 ◽  
Vol 9 (9) ◽  
pp. 608-613
Author(s):  
Dr. Swapna Lingaldinna,Dr. Himabindu Singh,Mona Sharma*
Keyword(s):  
Newborn Care ◽  
Standard Of Care ◽  
The Novel ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Care Community ◽  
Novel Device ◽  
Sick Newborn ◽  
Central Apneas ◽  
Neonatal Apnea

Objective: To measure the accuracy of a novel device in detecting Bradycardia andDesaturation (B&D) events and to determine its efficacy in resolving apneas innewborns with comparison to standard monitor (which only detects B&D eventsand alerts).Design: This was a prospective observational study.Setting: Sick Newborn Care Unit of a large tertiary referral hospital in Hyderabad,India.Methods: 31 newborns were provided with a novel device, which monitored oxygensaturation and pulse rate and alarmed when values dropped below a set thresholdwhich is referred as an event, henceforth. The novel device also provided footstimulation in response to above-mentioned events. When the monitor alarmed, anurse attended to the baby to confirm whether the baby was breathing and whetherthe event had been resolved by the device. If the event had not resolved, appropriateaction as per the standard-of-care was performed.Results: The novel device “ApneBootTM” positively detected B&D events 94.03% oftimes as compared to the standard reference monitor. 56 of 67 observed B&D eventswere visually confirmed to be apneas, indicating that 83.6% of B&D eventscoincided with apneas. Of the 56 apneic events, 50 were central apneas, of which 35were resolved by the novel device, making the device’s efficacy of apnea resolution70%.Conclusion: The results of the study indicate that this novel device “ApneBootTM”is very effective in detecting and alarming B&D events, which coincides with theapnea, and resolving it by providing foot stimulation.Keywords: Novel Device, Neonatal Apnea, Low Birth Weight, Body Temperature,Kangaroo Mother Care, Community Health,

Synthetic and semi-synthetic drugs as promising therapeutic option for the treatment of COVID-19

2020 ◽  
Vol 20 ◽  
Author(s):  
Ekta Shirbhate ◽  
Preeti Patel ◽  
Vijay K Patel ◽  
Ravichandran Veerasamy ◽  
Prabodh C Sharma ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Antiviral Treatment ◽  
The Novel ◽  
Clinical Experiences ◽  
Synthetic Compounds ◽  
Synthetic Drugs ◽  
Global Pandemic ◽  
The World ◽  
Novel Coronavirus

: The novel coronavirus disease-19 (COVID-19), a global pandemic that emerged from Wuhan, China has today travelled all around the world, so far 216 countries or territories with 21,732,472 people infected and 770,866 deaths globally (as per WHO COVID-19 update dated August 18, 2020). Continuous efforts are being made to repurpose the existing drugs and develop vaccines for combating this infection. Despite, to date, no certified antiviral treatment or vaccine prevails. Although, few candidates have displayed their efficacy in in vitro studies and are being repurposed for COVID-19 treatment. This article summarizes synthetic and semi-synthetic compounds displaying potent activity in their clinical experiences or studies against COVID-19 and also focuses on mode of action of drugs being repositioned against COVID-19.

Measuring Earwax Cortisol Concentration Using a Non-Stressful Method (Preprint)

2020 ◽  
Author(s):  
Andrés Herane-Vives
Keyword(s):  
Cortisol Level ◽  
Local Stress ◽  
Extraction Methods ◽  
Cortisol Concentration ◽  
The Novel ◽  
Sampling Device ◽  
Related Factors ◽  
Novel Device ◽  
Cortisol Levels ◽  
The Right

BACKGROUND “Short-term” samples are not the most appropriate for reflecting Chronic Cortisol Concentration (CCC). Although hair is used for reflecting the systemic cortisol level over “long-term”, its use appears clinically problematic. Local stress and non-stress related factors may release a circumscribed cortisol secretion that is accumulated in hair. Non-stressful earwax extraction methods may provide a more accurate specimen to measure CCC. OBJECTIVE Correlate cortisol levels using hair, serum and earwax samples METHODS Earwax from both ears of 37 controls were extracted using a clinical procedure commonly associated with local pain. One month later, earwax from the left ear side was extracted using the same procedure, and earwax from the right ear side was comfortably extracted, using an earwax self-sampling device. Participants also provided one centimetre of hair that represented the retrospective month of cortisol output, and one serum sample that reflected the effect of systemic stressors on cortisol levels. Earwax (ECC), Hair (HCC) and Serum (SCC) Cortisol Concentration were correlated and compared. Confounders´ effect on cortisol levels were studied. RESULTS Serum showed the largest and hair the lowest cortisol concentration (p<0.01). Left-ECC was larger than Right-ECC (p=0.03). Right-ECC was the only sample unaffected by confounders (all p>0.05). Right-ECC and HCC showed the only significant association (r=0.39; p=0.03). CONCLUSIONS The self-sampling device did not represent a local stressor for the ceruminous glands. It provided the cortisol level with the least likely to be affected by confounding factors over the previous month. ECC using the novel device may constitute another accurate, but more suitable and affordable specimen for measuring CCC.

Simulation of Cerebrospinal Fluid Leak Repair Using a 3-Dimensional Printed Model

2021 ◽  
pp. 194589242110035
Author(s):  
Muhamed A. Masalha ◽  
Kyle K. VanKoevering ◽  
Omar S. Latif ◽  
Allison R. Powell ◽  
Ashley Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Great Part ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Clinical Environment ◽  
Training Tool ◽  
3 Dimensional ◽  
Clinical Scenarios ◽  
Before And After ◽  
3D Printed

Background Acquiring proficiency for the repair of a cerebrospinal fluid (CSF) leak is challenging in great part due to its relative rarity, which offers a finite number of training opportunities. Objective The purpose of this study was to evaluates the use of a 3-dimensional (3D) printed, anatomically accurate model to simulate CSF leak closure. Methods Volunteer participants completed two simulation sessions. Questionnaires to assess their professional qualifications and a standardized 5-point Likert scale to estimate the level of confidence, were completed before and after each session. Participants were also queried on the overall educational utility of the simulation. Results Thirteen otolaryngologists and 11 neurosurgeons, met the inclusion criteria. A successful repair of the CSF leak was achieved by 20/24 (83.33%), and 24/24 (100%) during the first and second simulation sessions respectively (average time 04:04 ± 1.39 and 02:10 ± 01:11). Time-to-close-the-CSF-leak during the second session was significantly shorter than the first (p < 0.001). Confidence scores increased across the training sessions (3.3 ± 1.0, before the simulation, 3.7 ± 0.6 after the first simulation, and 4.2 ± 0.4 after the second simulation; p < 0.001). All participants reported an increase in confidence and believed that the model represented a valuable training tool. Conclusions Despite significant differences with varying clinical scenarios, 3D printed models for cerebrospinal leak repair offer a feasible simulation for the training of residents and novice surgeons outside the constrictions of a clinical environment.

Safety and efficacy of the porcine small intestinal submucosa dural substitute: results of a prospective multicenter study and literature review

2007 ◽  
Vol 106 (6) ◽  
pp. 1028-1033 ◽  
Author(s):  
Ghassan K. Bejjani ◽  
Joseph Zabramski ◽  
_ _
Keyword(s):  
Wound Infection ◽  
Small Intestinal Submucosa ◽  
Csf Leak ◽  
Dural Repair ◽  
Dural Substitute ◽  
Csf Leakage ◽  
Porcine Small Intestinal Submucosa ◽  
Small Intestinal ◽  
Intestinal Submucosa

Object Dural substitutes are often needed after neurosurgical procedures to expand or replace dura mater resected during surgery. A new dural repair material derived from porcine small intestinal submucosa (SIS) was evaluated in a prospective multicenter clinical study. Methods Between 2000 and 2003, 59 patients at five different institutions underwent dural reconstruction with the SIS dural substitute, with a minimum follow up of 6 months. The primary goals of the study were to assess the efficacy and safety of the SIS dural substitute according to the rate of cerebrospinal fluid (CSF) leakage, infection, and meningitis. Chiari malformation Type I decompression (32 patients) and tumor resection (18 patients) were the most common procedures performed, with 81% of SIS grafts implanted in the posterior fossa or spine. There was one case of a CSF leak (1.7%), two cases of wound infection (3.4%), and no cases of bacterial meningitis (0%) in the 58 patients available for follow up. In both cases of wound infection, the SIS graft acted as a barrier to infection and was not removed. Intraoperatively, a watertight seal was achieved in all 59 cases. On follow-up imaging available in 27 patients there was no evidence of any adverse reaction to the graft or of cerebral inflammation. Conclusions The SIS dural substitute demonstrated substantial efficacy in these patients after a mean follow up of 7.3 ± 2.2 months. Rates of infection, CSF leakage, and meningitis were comparable to those reported for other dural substitute materials. A lack of adverse reactions to the graft, favorable safety profile, and clinical efficacy all point to the utility of this material as an alternative for dural repair.

scholarly journals Reflective Practice for Professional Development Among Nursing Instructors

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Boniface Harerimana
Keyword(s):  
Nursing Students ◽  
Reflective Practice ◽  
Health Professionals ◽  
Action Plan ◽  
Self Awareness ◽  
Work Experiences ◽  
Clinical Experiences ◽  
Clinical Scenarios ◽  
Reflection In Action ◽  
Reflection On Action

Reflective practice among health professionals involves considering and questioning clinical experiences. The process of learning through work involves “reflection-in-action” (the skills of self-awareness, critical analysis, synthesis, and evaluation while executing clinical activities),  and “reflection-on-action” which involves retrospective reviews of the clinical scenarios  experienced by  health professionals (Clouder, 2000; Duffy, 2009). Johns (1995)  suggests that reflective practice is the professional’s ability to understand and learn from work experiences to achieve more effective and satisfying followup work experiences. Nursing instructors play a crucial role in helping nursing students consolidate taught theories and practice through guided and regular reflection on professional experiences (Duffy, 2009). To be effective guides, nursing instructors require the knowledge and skills necessary to implement reflective practice techniques into their teaching. This workshop actively engages participants in examining reflective practice by building on Gibbs’ (1998) six-step reflective cycle (i.e., description, feelings/thoughts, evaluation, analysis, conclusion, and action plan). The goal is to help instructors develop the necessary abilities to guide reflective practice among their students.

scholarly journals PYROLYSIS OF SOLID WASTE AND ITS COMPONENTS IN A LAB SCALE INDUCTION-HEATING REACTOR

Detritus ◽  
2021 ◽  
pp. 107-112
Author(s):  
Oscar Sosa ◽  
Sylvie Valin ◽  
Sébastien Thiery ◽  
Sylvain Salvador
Keyword(s):  
Beech Wood ◽  
Fast Pyrolysis ◽  
Fluidized Bed Reactor ◽  
Thermochemical Conversion ◽  
Homogeneous Distribution ◽  
The Novel ◽  
Reaction Products ◽  
Heating Rates ◽  
Fast Heating ◽  
Novel Device

The present study investigates the thermochemical conversion of Solid Recovered Fuel (SRF), represented by selected “model materials”. A laboratory-scale induction heated device was specifically developed to achieve fast pyrolysis conditions close to those encountered in a fluidized bed reactor. The novel device can handle up to 5 grams of solid, allowing fast heating rates (near 70°C/s) and a homogeneous distribution of temperature all along the reactor. Pyrolysis tests of a SRF sample and four model materials (Polyethylene, Polyethylene Terephthalate, beech wood, cardboard) were performed at 800°C. The yield and composition of the produced gas for each sample were determined. Experimental results will help to elucidate the relation between the initial components of waste derived fuels and the obtained reaction products.

Development of a Simulation Model for Optimization of Business Process

2018 ◽  
pp. 26-42
Keyword(s):  
Simulation Model ◽  
Model Validation ◽  
Business Process ◽  
Research Question ◽  
Future Research ◽  
The Novel ◽  
Model Based ◽  
Model Validity ◽  
Proposed Model ◽  
New Research

Optimization of business process assists in efficient organization of business process. For the success of optimization of business process, a simulation model based on gap processes for the analysis of buyers' burstiness in business process has been proposed. However, the model has to be validated. The aim of the research is to implement a validation approach to the simulation model based on gap processes for the optimization of business process underpinning elaboration of a new research question on the model validity. The meaning of the key concepts of “validation,” “model validation,” and “model validation approach” is studied. The results of the present research show that the application of real system measurements validates the simulation model for the optimization of business process. The novel contribution of the manuscript is revealed in the newly created research question on the proposed model validity. Directions of future research are proposed.

scholarly journals A Novel Earwax Method to Measure Acute and Chronic Glucose Levels

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1069
Author(s):  
Andrés Herane-Vives ◽  
Susana Espinoza ◽  
Rodrigo Sandoval ◽  
Lorena Ortega ◽  
Luis Alameda ◽  
...  
Keyword(s):  
Postprandial Glucose ◽  
The Novel ◽  
Sampling Device ◽  
Clinical Method ◽  
Postprandial Glycemia ◽  
Novel Device ◽  
Glucose Levels ◽  
Standard Serum

Diabetes is the fourth cause of death globally. To date, there is not a practical, as well as an accurate sample for reflecting chronic glucose levels. We measured earwax glucose in 37 controls. Participants provided standard serum, glycated hemoglobin (HbA1c) and earwax samples at two time-points, one month apart. The specimens measured baseline fasting glucose, a follow-up postprandial glucose level and a between sample chronic glucose, calculated using the average level on the two occasions. The baseline earwax sample was obtained using a clinical method and the follow-up using a novel self-sampling earwax device. The earwax analytic time was significantly faster using the novel device, in comparison to the clinical use of the syringe. Earwax accurately reflected glucose at both assessments with stronger correlations than HbA1c. Follow-up postprandial concentrations were more significant than their respective fasting baseline concentrations, reflecting differences in fasting and postprandial glycemia and more efficient standardization at follow up. Earwax demonstrated to be more predictable than HbA1c in reflecting systemic fasting, postprandial and long-term glucose levels, and to be less influenced by confounders. Earwax glucose measurements were approximately 60% more predictable than HbA1c in reflecting glycemia over a month. The self-sampling device provided a sample that might accurately reflect chronic glycemia.

Sign in / Sign up

Export Citation Format

Share Document